Autumn 2016

From the Director

iCAHE researchers have had a busy start to the year with new research projects coming from Australian state governments, and Australian and overseas industry partners. All are focused on service delivery questions, and have challenged the iCAHE researchers with evaluating strength of the body of evidence in terms of ‘should care be recommended?’. Managing the tasks required to keep multiple projects going successfully on the same timeline, is a testament to the integrity, planning, team work, loyalty, organisation, vision and hard work of the iCAHE core research staff (Dr Julie Luker, Kate Kennedy, Dr Jeric Uy, Ashley Fulton, Dr Michelle Guerin, Olivia Hill, Dr Luke Perraton). As always Jan Kooymans provides efficient, forward thinking, problem-solving administrative support for all iCAHE members. After helping across projects for the last few months, Liz Lynch has taken up a postdoc position in association with the Centre for Research Excellence Stroke Rehabilitation and Brain Recovery. Judith Hocking and Maura McInerney recently commenced work as iCAHE RAs on new industry projects.

This newsletter features Asterie Twizeyemariya, the health economist working part time in iCAHE. iCAHE has already felt the value of Asterie’s skills in terms of health economics lunchtime training sessions, and her input in economic evidence analysis.

There are four new PhD students sitting in the iCAHE offices Alvin Atlas, Ines Serrada, Micarla Sexton and Paul Reid.

Julie Luker and her team were successful in gaining access to national stroke audit data for analysis, and the Stroke and Rehabilitation Research Area of iCAHE have provided funding for the audit to proceed.

Karen Grimmer spent February and March in South Africa working on the tasks to be completed in the third year of the Medical Research Council funded South African Guidelines Excellence project. One exciting output of this project has been that SAGE researchers are working with policy-makers in the South African Dept Health (national and provincial offices) to write comprehensive evidence-informed allied health care pathways that cross sectors. This work should put AH in South African primary healthcare in a better position to make an impact nationally with evidence-informed rehabilitation and disability management practices. Many thanks to Steve Milanese for directing iCAHE affairs and projects in Karen’s absence.

Journal clubs continue to be a focus of iCAHE evidence-implementation and training activities, please check the iCAHE website Journal clubs section or contact Michelle Guerin or Olivia Hill at iCAHEjournalclub@unisa.edu.au for details. Kate Kennedy has fine-tuned the iCAHE website, please visit it to see what is new in iCAHE products.

Each iCAHE Research Area Team (RAT) has started the year strongly with great research happening at staff and student levels. See the iCAHE Research Area Team webpages for details on these activities. Of note is the exponential increase in research outputs from the Medical Radiations RAT since Eva Bezak has taken up the professorial post in this area. Congratulations to Eva and your researchers!!

A major initiative in iCAHE this year is the focus on low value care. With financial support from the Sansom Institute, Ashley Fulton is leading a team which is reviewing the literature to determine descriptors of low value and high value care, for the ‘vehicle’ of low back pain. Once the evaluation processes are determined for this condition, we plan to put the allied health and related management of other common conditions under the microscope. Watch this space!

Partner Update

Within the Transforming Health space, there have been several key developments since my February update. Firstly, Vickie Kaminski, Deputy Chief Executive -Transforming Health has commenced. Vickie’s initial focus is on meeting with clinicians and staff regarding the work that is underway including intra-Local Health Network service moves.

The Transforming Health Allied Health project, to identify the key priority areas where allied health services across 7 days are required to support patient recovery, prevent patient deterioration, and facilitate timely discharge continues to progress. The UniSA’s International Centre for Allied Health Evidence (iCAHE) through its partnership with the Allied and Scientific Health Office continues to support this Model of Care progression. Most recently this support has been through the delivery of Work Bundle 2: Does the timeliness of allied health assessment/treatment/intervention impact on patient outcomes in specific conditions?

The Transforming Health Expert Working Groups are currently working towards the review and redesign of health services within the following areas:

Orthogeriatrics

Acute Hip Fracture Management

Acute Coronary Syndrome

Chest Pain

Rehabilitation Services Project

Statewide Paediatric Surgical Governance

Stroke

All Expert Working Groups (EWGs) incorporate Allied Health membership and the Allied Health Services 7 Day Services intersects with the respective project managers to ensure continuity of workforce and clinical practice considerations. Further information on Transforming Health is available on the website. www.transforminghealth.sa.gov.au

The Consumer Engagement Research Area Team

The Consumer Engagement Research Area Team is now led by University of South Australia, School of Health Sciences and iCAHE staff member, Dr Angela Berndt following foundational development by Debra Kay. Outputs and impact from 2015 include publications and the successful launch of the Professional certificate in Consumer Engagement, which is is currently being reviewed for wider applicability and scope within the School of Health Sciences UniSA.

Angela is an occupational therapist who embarked on the journey being a researcher and educator 16 years into her clinical career. Since that transition and for the past 13 years, Angela has been part of the teaching and tutoring team for the primary health care and participatory community practice courses in occupational therapy. During this period she has learnt alongside students the ways that clinical reasoning, reflective skills, social views of health, capacity building, community development, participation and partnership meld and work in practice.

Angela is pleased to take this role in 2016 to work in iCAHE to explore how, when, why and with whom a consumer engagement focus can further underpin or be successfully integrated into research conducted within each team focus. As part of capacity building strategy, the consumer engagement area on the iCAHE website has embedded some research tools and related frameworks that can be accessed to support the conceptual development of projects.

Project Update

The effectiveness of comprehensive care in acute settings

The International Centre for Allied Health Evidence (iCAHE) was tasked with undertaking a rapid literature review (Sax Institute Evidence Check) regarding the best available research evidence for the effectiveness of comprehensive care in acute settings as defined by the Sax Institute on improving outcomes. The reason for the review is to inform the Australian Commission on Safety and Quality in Health Care initiatives in its current revision of the National Safety and Quality Health Service (NSQHS) Standards, with the intention of releasing version two in 2017/18. A new NSQHS Standard on Comprehensive Care is currently being developed and will be added to the Standards. The final Sax Institute Evidence Check can be found on the iCAHE Research Hub page: http://www.unisa.edu.au/Research/Sansom-Institute-for-Health-Research/Research/Allied-Health-Evidence/Quality-Care/Research-Hub/#research

The International Centre for Allied Health Evidence (iCAHE) recently developed a user-friendly instrument for assessing the quality of clinical guidelines. The iCAHE Guideline Quality Checklist allows guideline users to quickly and accurately assess the quality and usefulness of clinical guidelines.(1,2)

The iCAHE Guideline Quality Checklist was recently included in a systematic review published in the German Medical Association’s peer-reviewed journal Deutsches Ärzteblatt.(3) The systematic review discussed the comprehensiveness, orientation and relevance to clinical practice of the iCAHE Checklist, alongside three other ‘rapid assessment instruments’. The figure within this systematic review highlights the strengths of the iCAHE Checklist; in particular, its ability to evaluate how rigorously a guideline was developed and how a guideline links its recommendations to the underlying evidence base.

In the future as more clinical guidelines are developed, greater onus will be placed on clinicians and health care organisations to choose and implement these guidelines in clinical practice.(4) The iCAHE Guideline Quality Checklist is a freely available and validated instrument that can be read alongside clinical guidelines to help determine their quality and clinical utility.

iCAHE and the SA Health Office for the Ageing: Engaging Baby Boomers

The SA Health Office for the Ageing commissioned iCAHE to conduct a rapid review of the evidence to find the best practice for the engagement of baby boomers in policy development. A review of the published and grey literature was conducted on effective approaches to engaging baby boomers with policy makers, however, no articles or reports were found that were relevant to the specific research questions asked. This lead to iCAHE developing a Consumer Engagement Model to plan for effective baby boomer engagement to inform policy makers in the healthcare system. The first paper on the development of this model has now been published.

Resources for You

With approximately 6,500 views this quarter, the iCAHE critical appraisal tool (CAT) web page is still our most popular page, hardly surprising, with approximately 56 freely available CATs in addition to CEBM’s CAT-maker; computer-assisted critical appraisal software. Critical appraisal is an integral process in Evidence Based Practice, and aims to identify methodological flaws in the literature and provide consumers of research evidence the opportunity to make informed decisions about the quality of research evidence. The page hosts tools to critically appraise a large range of study designs (including the iCAHE guideline checklist) as well as having some useful video tutorials on how to conduct a critical appraisal and how best to incorporate this into clinical decision making.

Feature Guideline - See the latest featured guideline, International Consultation on Incontinence Questionnaire Urinary Incontinence Quality of Life Module (ICIQ-LUTSqol)

Actions in Allied Health

SMART STROKES is a not-for-profit conference organised by clinicians and researchers for clinicians and researchers with a strong focus on improving the clinical care and management of stroke. Any profit made goes into the SMART STROKES Scholarship fund, which has also received generous education grants.

In light of significantly increasing governmental focus on keeping their ageing populations more healthy and active, this conference will prove to be the largest gathering of experts and stakeholders in the field of Active Ageing ever assembled. We are anticipating international delegates will meet from more than 30 countries in July 2016 at the Melbourne Convention & Exhibition Centre and to that end we invite you to be part of this exciting event.

The Primary Health Care (PHC) Research Conference is the national knowledge exchange opportunity for people working across the PHC frontline.

If you are working in PHC, then this conference is the place to present, hear, network, debate and spark dynamic ideas that make a difference to health outcomes. The theme for the 2016 PHC Research Conference, Reform and innovation in PHC policy and practice, guides presenters to demonstrate ways in which their work and expertise contributes to innovative, policy-relevant, priority-driven research.

Lucas S., Kumar S., Leach M. 2016. Use of complementary and alternative medicine in children: research opportunities and challenges in an ever growing field. Australian Journal of Herbal Medicine. 2015 27(4)

Research Spotlight

Welcome to Asterie

I joined iCAHE in November 2015 as a health economist. I have already been involved on a number of different projects including research collaborations with colleagues in iCAHE and in producing a lunch discussion on health economics to help the understanding of economic concepts and how they are applied to health.

On a personal and professional note, I am born and raised in Rwanda, I studied in Canada where I graduated with a Ph.D. in economics and I arrived in Australia with my family in 2013. My previous experiences include working with immigrants in prevention of HIV in a community setting, health policy analysis, and research in economic evaluation of programs. I am involved with the Health Economics and Social Policy Research Group working on childhood adversities, their impact on health in adulthood and on resource planning. My main interests include economic evaluation methods, their application on health intervention programs and developing an evidence-base that can be used by policy-makers to more effectively allocate resources in the prevention of chronic disease. I like listening to music, reading, hiking and discovering new places and people.

Being part of the iCAHE team is a good experience. I believe there is a place for economic evaluation and for the application of health economics to guidelines, and to health policy issues that impacts the quality of life of the patients and benefits society.

Asterie Twizeyemariya

Cochrane training

I was fortunate to be supported by the iCAHE Methodology group to attend the 3-day Cochrane training workshop in Melbourne from March 21st-23rd. The first day covered the basics of defining a research question and assessing risk of bias, which was reassuringly familiar (albeit not terribly stimulating) as we do this on a regular basis for reviews conducted through iCAHE. The second and third days were more interesting - on the second day we covered analysis of different sorts of data, meta-analysis of data and ways to ‘weight’ different studies when the quality of included studies is inconsistent. Being shown the tips and tricks of the Revman software package was also really useful. On the third day we covered analysing non-standard studies and interpretation of the analyses. The things I learnt at the workshop will be invaluable in the Cochrane systematic reviews I am involved in with other iCAHE staff members – we are reviewing interventions to promote the uptake of evidence-based practice in acute stroke units, and reviewing the evidence about circuit class training for people with stroke.

Liz Lynch

Reflection on the 2016 ASSMIRT in Brisbane

Attending the 2016 ASSMIRT conference has provided with me with numerous, unmeasurable experiences I wouldn’t be able to obtain anywhere else. In particular, the attendance of one particular seminar:

This presentation was the sole purpose I attended this conference, as this research question is extremely similar to my own research. Having just completed a literature review of articles related to education for lateral elbow radiography and coming up with very few, it was beneficial to analyse the methodological processes Daniel undertook. I was able to make contact with Daniel after two of the seminars he presented and I received his contact details. Most importantly, I was able to ask him numerous questions about his method so I could see in which ways it differs to mine. As his results were ultimately deemed to be statistically insignificant, it was interesting to hear from him why he thought this was so. Hopefully our research can avoid the pitfalls that he stated his possessed.

As Daniel has yet to publish his study, I was able to ask him questions he may have been hesitant to discuss outside the conference. Furthermore, his abstract was available through the ASSMIRT website, which was previously unavailable. Limitations of his study where presented in the seminar, where they may have been previously unobtainable.

The most valuable learning experience was not only attending the seminar where Daniel summarised his results, but also the workshop in which he was able to teach the audience about his educational intervention used in his study. This clearly clarified his intervention and how it differs to ours, which is important because the type of intervention and the way he presented his theorem is the only difference between our studies.

I also attended all of the other presentations, which ranged from CT, patient care, leadership and student learning. These other presentations were beneficial as it was exciting to be one of the first to hear about these new innovations that people have developed and implemented in their department. This conference has taught me of the importance of research in improving radiographer worklife and patient outcomes.

Isabella Calabrese

Farewell

The iCAHE team extends a warm farewell and their best wishes to Debra Kay, Liz Lynch and Kate Kennedy. We wish them all the best into the future.